After some surgical intestinal procedures, for example, in those in which a new anastomosis is formed, it is valuable to maintain intestinal drainage and decompression, to avoid the consequences of ileus, and to safeguard the anastomosis. Various mechanisms to maintain intestinal drainage and decompression after surgery are known and include nasogastric tubes, nasointestinal tubes, cecostomy tubes, rectal tubes, obturating balloon colostomy devices and intracolonic bypass tubes. Surgical procedures and techniques are also available to maintain intestinal drainage and decompression after gastrointestinal surgery and include gastrostomies, cecostomies, ileosotomies and colostomies. There are drawbacks to each of these mechanisms and procedures.
Nasogastric tubes partially aspirate gastric contents, and to a small degree prevent distal air passage and bowel distension. However, gastric aspiration is often incomplete and succuss entericus produced by the bowel, and bacteria and gasses generated within the bowel, are not effectively evacuated. In spite of these deficiencies, nasogastric tubes are still used by many surgeons after colonic surgery, but are decreasingly popular.
While nasointestinal tubes (e.g., a Cantor Tube) may decompress the small bowel slightly better, they may not effectively prevent gastric ileus. They are usually placed preoperatively, adding to patient discomfort, and they are no more effective postoperatively than nasogastric tubes.
Cecostomy tubes and cecostomies are known to be inefficient for diversion of the fecal stream, and have been largely abandoned in favor or ileostomies or colostomies. Cecostomy tubes and cecostomies are used for colonic decompression but not for fecal diversion and have limited use postoperatively.
Ileostomies and colostomies are constructed by bringing bowel through the abdominal wall and creating an opening at skin level. Their formation is time consuming and they are fraught with complications such as abscess, hernia, prolapse and stricture. Their closure requires additional surgery. These stomas may cause intestinal obstruction. Even after temporary stomas have been closed, the adhesions which have been formed by the creation and closure of the stomas may lead to intestinal obstruction. Ileostomies and colostomies are sometimes used to protect a distal anastomosis but only when the surgeon believes that the anastomosis is particularly vulnerable to disruption.
Rectal tubes have been used to decompress the rectum, but they typically fail to divert the fecal stream away from an anastomosis and become ineffective when plugged by fecal matter. Rectal tubes are rarely used in the postoperative period.
In view of the drawbacks of the mechanisms and procedures described above, there is a need for a new technique and apparatus for decompressing the colon in the postoperative period, which is capable of effectively aspirating the colon and diverting fecal matter away from a colonic anastomosis.